The color change in artificial white spot lesions measured using a spectroradiometer

The Effect of Non-Invasive Treatment Techniques on the Color Masking Ability and Surface Roughness of Induced Enamel Lesions (An in vitro Study)

Aim of the Study

The aim of this in vitro study was to evaluate the effect of the resin infiltration technique and remineralization of induced enamel caries with fluoride solution on the color masking of white spot lesions and surface roughness.

Materials and Methods

A total of 45 sound teeth were used in this study. All the teeth were sectioned along the long axes into two halves, lingual and buccal to get 90 specimens. All specimens were immersed in a demineralized solution for 7 days. The specimens were divided randomly into three equal groups (n = 30) according to the type of treatment; Group 1 (n = 30) was treated with fluoride varnish (Clinpro); Group 2 (n = 30) was treated by resin infiltration (Icon); and Group 3 (n = 30) was used as a control group with no treatment. The color and surface roughness were measured three times at baseline (T1), directly after induction of artificial white spot lesions (WSLs) (T2), and directly after application of the treatment options (T3). The colors were measured using a portable reflective spectrophotometer and the 3D surface roughness was measured using a Light Sectioning Vision System. Data were collected and statistically analyzed using T test and Mann-Whitney U test.

The Results

Surface roughness was almost equal in the study groups with no statistically significant differences reported. Icon showed slightly higher color scores than that of ClinPro.

Conclusions

The Icon produced favorable esthetic results compared to the fluoride therapy while no significant differences were reported regarding the surface roughness.

In vitro evaluation of a novel fluoride-coated clear aligner with antibacterial and enamel remineralization abilities

OBJECTIVE

To investigate the antibacterial and enamel remineralization performances as well as physicochemical properties and biocompatibility of a fluoride-coated clear aligner plastic (FCAP).

MATERIALS AND METHODS

FCAP and normal clear aligner plastic (CAP) was bought from the manufacturer (Angelalign Technology Inc, China). The FCAP was observed under scanning electron microscopy. Its element composition, resistance to separation, contact angle, and protein adhesion performance were characterized. Colony-forming unit (CFU) count and 3-(4,5)-dimethylthiazol(-z-y1)-3,5-diphenyltetrazolium bromide (MTT) assay were used to evaluate the antibacterial ability of Streptococcus mutans. Fluoride release-recharge patterns were obtained. Apatite formation was evaluated after immersing FCAP in artificial saliva. Enamel remineralization capability was evaluated in the demineralization model (immersing samples in demineralization solution for 36 h) and pH cycling model (immersing samples in demineralization solution and remineralization solution in turns for 14 days). Cell Counting Kit-8 (CCK-8) and live/dead cell staining kits were used for cytotoxicity assay.

RESULTS

The FCAP showed uniformly distributed fluoride and did not compromise protein adhesion performance. CFU count (5.47 ± 0.55 for CAP, 3.63 ± 0.38 for FCAP) and MTT assay (0.41 ± 0.025 for CAP, 0.28 ± 0.038) indicated that the FCAP had stronger antibacterial activity compared with normal CAP (P < 0.05 for both evaluations). The FCAP could release fluoride continuously for 14 days and could be recharged after immersing in NaF solution. The FCAP could induce the formation of hydroxyapatite in artificial saliva and could reduce the microhardness decrease, color change, and mineral loss of enamels in both two models (P < 0.05 for all evaluations). CCK-8 and live/dead cell staining analyses showed that the coating did not compromise the biocompatibility of the clear aligner (P > 0.05 for CCK-8 evaluation).

CONCLUSIONS

The FCAP had antibacterial, fluoride recharge, and enamel remineralization abilities while it did not compromise physicochemical properties and biocompatibility.

CLINICAL RELEVANCE

The FCAP has the potential to prevent enamel demineralization during clear aligner treatment.

Effect of different types of acid-etching agents and adhesives on enamel discoloration during orthodontic treatment

Background. Acid etching and bonding is a routine process in orthodontic treatment. The present study aimed to evaluate enamel discoloration after using different types of acid etching and adhesive agents.

Methods. A total of 105 extracted human premolars were divided into six groups regarding the type of acid etching agent: solution and gel of 37% phosphoric acid, and type of self-cured adhesive agent: Unite (3M, fluoride-free), Resilience (Ortho Technology), and Rely-a-Bond (Reliance, fluoride-releasing adhesive), with each group containing 15 specimens. All the selected teeth were subjected to a staining process, and color parameters were determined using a spectrophotometer.

Results. The type of phosphoric acid (solution or gel) had no significant effect on the color change of enamel (P >0.05). Resilience significantly changed the enamel color compared to the Unite and Rely-a-Bond (P <0.001). There was no significant difference in color change between the Unite and Rely-a-Bond adhesives (P =0.67). The difference in color change between all the three time intervals (T0-T1, T1-T2, and T0-T2) was significant (P <0.001).

Conclusion. In this study, the type of phosphoric acid (solution or gel) did not result in any significant difference in enamel color. Also, considering the lack of the effect of the orthodontic adhesive type in terms of fluoride release or no fluoride release, it can be concluded that this is most affected by the commercial brand of adhesives.

Color Masking White Fluorotic Spots by Resin Infiltration and Its Quantitation by Computerized Photographic Analysis: A 12-month Follow-up Study

OBJECTIVE

To manage three cases of mild to moderate fluorosis by resin infiltration technique and to quantify the tooth color changes by measuring CIE L*a*b* values of digital photographs and calculating ΔE₀₀ based on the CIEDE2000 formula using Adobe Photoshop software.

METHODS AND MATERIALS

Three cases of mild to moderate fluorosis were treated with a combination of bleaching and a resin infiltration technique. CIE L*a*b* values of 18 fluorosed spots were measured from digital photographs of these cases at four different stages-preoperative, postbleaching, postinfiltration and at 12-month follow-up-using Adobe Photoshop software, and ΔE₀₀ was calculated based on the CIEDE2000 formula. The ΔE₀₀ values of all 18 points obtained at different stages were submitted to statistical analysis (α=0.05).

RESULTS

In all the cases reported, clinically as well as by the photographic color analysis, it was found that the technique masked the lesions, improving the patients' esthetics, which was maintained even at 12-month recall. Statistically significant difference in ΔE₀₀ values was present between comparison of all stages (p<0.001) except between postinfiltration and the 12-month follow-up stage (p=0.642).

CONCLUSION

A resin infiltration technique helped in the satisfactory management of white spot lesions of fluorosis, which were stable even at 12-month follow up. Quantitation of the changes was achieved using Adobe Photoshop software.

An In Vitro Study on the Effect of Amorphous Calcium Phosphate and Fluoride Solutions on Color Improvement of White Spot Lesions

The ability of remineralizing agents to improve the color of white spot lesions (WSL) is an important aspect that should be investigated. The aim of this study was to evaluate the effects of 0.05% amorphous calcium phosphate (ACP), 0.5% ACP, and 0.05% fluoride solutions, as well as artificial saliva on the color improvement of white spot lesions (WSLs). In this in vitro study, 50 human premolar teeth were randomly classified into five groups. At baseline, all the samples were assessed by using a colorimeter (E0). Then, white spot lesions were induced on the surface of the teeth by means of a pH-cycling model, and the colorimeter was used again (E1). Afterwards, samples of the 1st and 2nd groups were kept in 0.05% ACP and 0.5% ACP solutions for 1 min/day, respectively. The 3rd group specimens were placed in 0.05% fluoride solution for 1 min/day. The other two groups were kept in artificial saliva and distilled in water separately. All the samples were assessed by the colorimeter for a third time (E2). We found no significant difference between the groups in ∆E1. There was also no significant difference among 0.05% ACP solution, 0.5% ACP solution, 0.05% fluoride solution, and artificial saliva considering ∆E2. However, a significant difference was noted between the above-mentioned solutions and distilled water in ∆E2. With respect to ∆E3, there were considerable differences between ACP solution and artificial saliva. The same results were obtained for the difference between fluoride solution and artificial saliva. However, no significant difference was found among 0.05% ACP, 0.5% ACP, and 0.05% fluoride solutions in terms of ∆E3. In Conclusion, ACP is as effective as fluoride in the color improvement of WSLs and the recommended treatment for this purpose is daily use of 0.05% ACP, 0.5% ACP or 0.05% fluoride solutions.

The in vitro and in vivo reproducibility of a video-based digital imaging system for tooth colour measurement

OBJECTIVES

To assess the robustness of a new custom built video-based digital imaging system (VDIS) for measuring tooth colour and whiteness under in vitro and in vivo conditions.

METHODS

The VDIS imaging system was developed for tooth colour measurement and evaluated in vitro and in vivo. The in vitro validation used extracted human teeth (HT, n=14) stored in water and VITA Classical shade guide tabs (SG, n=16). These were measured by the VDIS at baseline, 5min, 2h, 1 week and 2 weeks to evaluate the system repeatability. For in vivo validation, adult volunteers (male/female, n=34) with two natural, unrestored central incisors had their teeth imaged using the VDIS at baseline, 5min and 2h (3 images each) by two different operators to evaluate time and operator effects. Between taking individual images, subjects moved from the imaging-frame to assess the effect of re-positioning on reproducibility. From the in vitro and in vivo images, the average tooth RGB values were obtained, and the CIELAB values and a tooth whiteness index WIO value were calculated. Repeatability and reproducibility of VDIS imaging system was assessed using appropriate repeated measurement analysis techniques and ANOVA.

RESULTS

The measurement variations in vitro were between 1 and 2 units of ΔWIO and the average colour differences were less than 1 ΔE^*_ab unit. For the in vivo study, analysis of the CIELAB parameters and WIO showed that subject variability accounted for between 82 and 99% of the observed variability in the measurement process. The operator variability was less than 0.5% and the overall measurement error was found to be only 0.3% for WIO. Across assessment times the variability was less than 0.5%.

CONCLUSIONS

The dental imaging system V-DIS was shown to be a highly reproducible means for tooth colour and whiteness measurement.

CLINICAL SIGNIFICANCE

Digital imaging based techniques gives a highly reproducible approach to measuring tooth colour.

Tooth colour and whiteness: A review

OBJECTIVES

To review current knowledge concerning the application of colour science on tooth colour and whiteness description, measurement, distribution and its psychological impact.

DATA SOURCES

"Scopus" databases were searched electronically with the principal keywords tooth, teeth, colour, white, whiteness. Language was restricted to English and original studies and reviews were included. Conference papers and abstracts were excluded.

CONCLUSIONS

The appearance and colour of teeth are a common concern for patients across many populations and are associated with an increased desire for treatments that improve dental aesthetics, including tooth whitening. The application of colour science in dentistry has allowed the precise description of tooth colour and whiteness. Coupled with the advances in instrumental tooth colour measurement, such as spectrophotometers, colorimeters, spectroradiometers and digital imaging systems, these parameters are quantifiable in a reproducible and robust manner. These principles have been applied to the tooth colour distribution in many study populations, indicating, in general, differences in tooth colour for subject age and gender, but not for ethnicity. Psychophysical studies on tooth colour and whiteness via third party assessment of images indicate that whitened teeth lead to judgements that are more positive on personality traits such as social competence and appeal, intellectual ability and relationship satisfaction.

Bleaching Effects on Color, Chemical, and Mechanical Properties of White Spot Lesions

OBJECTIVE

The purpose of the study was to evaluate the effect of bleaching on teeth with white spot lesions.

METHODS AND MATERIALS

Carious lesions with standardized whiteness were produced on the buccal and lingual surfaces of human premolars by pH cycling. Specimens were subjected to four experimental conditions (n=20/group) as follows: group 1, control; group 2, caries formation followed by remineralization using fluoride-containing casein phosphopeptide-amorphous calcium phosphate (CPP-ACP; Tooth Mousse Plus, GC, Tokyo, Japan); group 3, caries formation followed by bleaching using 10% carbamide peroxide; and group 4, caries formation followed by both bleaching and remineralization. The CIE L(*)a(*)b(*) color values were measured with a spectroradiometer, the mineral content was measured with electron probe microanalysis (EPMA) on the cross-sectional surface of each specimen, and the Knoop hardness test was carried out along the EPMA scan line. Two-way analysis of variance was performed with Tukey post hoc comparison.

RESULTS

The change in the CIE color values was not significantly different between the caries-formed (ΔE(*)=7.03) and the bleached enamel (ΔE(*)=7.60). Bleaching of the carious enamel extended the whiteness (ΔE(*)=3.38) without additional mineral loss (p<0.05). The remineralization treatment significantly increased the calcium (Ca), phosphate (P), and fluoride content of the subsurface lesion area (p<0.05). The cross-sectional microhardness values correlated well with the Ca and P content (R>0.80).

CONCLUSIONS

Bleaching reduced the color disparities between sound and carious enamel without deteriorating the chemical and mechanical properties. The application of CPP-ACP paste enhanced mineral deposition in the subsurface lesion area of carious enamel.